NEWS

Universal single payer health care activity around the country
by Shankar Durwaiswamy MASS-CARE Intern

MASS-CARE, the Massachusetts Campaign for Single Payer Health Care, is a coalition of more than 60 organizations, including the Massachusetts Nurses Association. It is working to pass legislation that would establish a universal single payer health care system in Massachusetts.

The focus of the coalition is to ensure health care for everyone at the state level rather than at the federal level because of the lack of political leadership to fight for national health care.

A single payer system, which would establish a state financed, consolidated, unified payment structure, would be the most cost-effective way of providing a universal health care system. 

In this article, we look at what people are doing to advance similar systems in their states. 

Legislation

The most direct attempts to push for single-payer health care in the states have been through legislation. Over the last two years, eight states have seen single payer bills introduced in their legislatures. These states include Missouri, Minnesota, New Mexico, Connecticut, Rhode Island, Montana, and Michigan. Here in Massachusetts, MASS-CARE will introduce a universal single payer bill to the Legislature again in December.

Most of these states have very similar bills, often borrowing sections on structure, benefits, and payment processes from each other’s bills. A few of the bills also have financing mechanisms included.

Connecticut’s bill, first introduced in 1999, will be re-introduced again this fall. The effort, spearheaded by the Connecticut Coalition for Universal Health Care, has garnered broad support. The coalition is hopeful that they will be able to pass the legislation this year, but a governor’s veto will likely await it. Nonetheless, passage through the assembly and senate would be a tremendous success and create more positive publicity for the single payer movement.

Despite concerted efforts by single payer campaigns in these states, political concerns have limited the potential for these bills to pass. Nonetheless, as the health care crisis deepens, many of these bills have gained increasing support over the years, often being voted out of committees before being voted down by the entire legislature. Supporters have wisely re-crafted and revised their legislative proposals from year to year to increase support within their respective state houses, while working to build broad coalitions of support in the community. A groundswell of public support, led by nonprofit, faith, and labor organizations would place the necessary political pressure on legislators to pass a universal health care program.

This is the model being followed here in Massachusetts, where the Massachusetts Health Security Trust legislation (H.1947/S.531) has been introduced since 1996. Since then, support within the Legislature has steadily increased. Currently, 38 percent of the state Senate and 31 percent of the state House of Representatives supports the legislation. Meanwhile, coalition-building and educational efforts continue, which, along with a growing health care crisis in the state, are developing broad-based public support for comprehensive health care reform.

Ballot initiatives

The political climate in the wake of the failure of President Clinton’s national health insurance plan in 1994 has made it difficult for many states to pursue single-payer health care through legislative channels. Increasingly, states have looked towards ballot initiatives that take the issue directly to the people. 

California undertook a $3.2 million initiative effort in 1994, but in the face of a multi-million dollar opposition campaign, could not muster the support necessary to pass it. Neighboring states in the northwest, Oregon and Washington, are currently pursuing this route, obtaining thousands of signatures to put the issue on the November ballot.

In Oregon, single-payer bills were introduced in the legislature twice in the 90s, but found little support. The Oregon Health Action Campaign, which now works with Health Care for All – Oregon, abandoned the hope for legislative success in 1997 and began working on a ballot initiative. The effort came to fruition this past January, when they formally filed the initiative with the Attorney General. Unfortunately, OHAC and HCFA objected to the proposed title/summary of the initiative to be put on the ballot. As a result, they decided to withdraw their ballot initiative with plans to file it again in the year 2002. The extra time may prove to be a blessing, as efforts to educate, organize, and fundraise will be stepped up in the next two years. 

Washington, along with Oregon, began exploring the possibility of a ballot initiative after the 1994 failure of a national health care system. At the time of this writing, Washington continues to work on gathering the necessary signatures to file the ballot initiative for this fall. If they cannot muster the necessary signatures, however, they hope to acquire enough signatures by December to file a legislative initiative which would force the hand of the state assembly. Should the legislative initiative be voted down, however, it would automatically become a ballot initiative for the year 2001.

Finally, here in Massachusetts, a November ballot initiative will allow citizens to force the state to develop a plan for universal health care by July 1, 2002. Also included in the initiative are a patients’ bill of rights with certain guidelines and a moratorium on the conversion of nonprofit hospitals to for-profit hospitals. Unlike the initiatives in other states that establish a single-payer system, this ballot initiative does not specify a particular mechanism for achieving universal coverage. Rather, it establishes an advisory committee that would make proposals to the Legislature.

Organizing

While various states explore legislative and initiative options, perhaps the best work being done by single-payer advocates is in those states that are still in the “planning” stages. In states like California and Maryland, the movement is building steam and long-term plans have been established to pursue a universal health care system.

California, led by the efforts of various Health Care for All-California chapters, passed Senate Bill 480 last year. The bill forces the state to commission a study on universal health care with concluding recommendations for implementing and funding such a program. While the bill does not include an explicit mandate to establish universal health care, it is a considerable victory in and of itself. Now, HCFA-California is in the process of a letter-writing campaign to persuade Governor Gray Davis to approve the $600,000 budget agreed on by the legislature for the study. HCFA is also undertaking a letter-writing campaign to convince the governor to apply for a grant from the federal government to help fund the study. The grant, however, would explicitly mandate that the state conclude with a strategy for implementing universal health care.

In Maryland, the Maryland Citizens’ Health Initiative just finished sponsoring a study that concluded that a single-payer health care system would be economically viable and efficient for the state. MCHI is now focusing their efforts on building a grassroots network of supporting organizations. They currently have 700 supporting groups and hope to sign “2000 by 2002.” In addition, they plan to host a number of educational forums to explore the options for universal health care. These political and educational efforts will hopefully bear fruit in a bill in 2002. Should the legislation be unsuccesful, MCHI plans to make it a major campaign issue in 2003 and pass a successful bill in 2004.

Federal support

The fight for universal health care in the states may receive a significant boost if federal legislation proposed by Rep. John Tierney of Massachusetts and Sen. Paul Wellstone of Minnesota comes to pass. Currently, states are required by federal law to meet certain provisions regarding the administration of health care under Medicare, Medicaid, and ERISA laws. Representative Tierney is sponsoring a bill (H.R. 4412) in Congress that would waive these provisions for states that provide a universal, comprehensive health care package to their citizens. Further, Tierney’s bill calls for Congress to aid in funding the state’s transition from the current system to a universal system.

Senator Wellstone’s bill would go even further. It would require that states develop a universal health care system by the year 2005. The bill prescribes certain guidelines that must be met and provides federal matching funds to help the states implement and finance their programs.

Developing the movement

As people in more states and local communities begin working for an equitable, quality, cost effective health care system, the energy and momentum spreads. The work around the country by so many dedicated people builds on each victory and lesson learned. Next year there will be even more activity to report!